PROJECT SUMMARY/ABSTRACT Every day in hospitals across the world, severe acute brain injury devastates patients and their families and challenges clinicians with a unique set of clinical care issues. As these patients with stroke or traumatic brain injury present with acute and neurologically devastating injury, their outcomes rely on early treatment decisions, and these decisions are virtually all made through discussions with surrogate decision makers and organized by critical care, neurosurgery or neurology clinicians who do not know these patients. Despite the remarkable recent advances in acute neurological care, morbidity and mortality remain high. With palliative care increasingly recognized as specialized medical care for patients with serious illness that focuses on improving communication about goals of care and quality of life, there remains a critical gap in understanding palliative care needs specific to patients with severe acute brain injury and their families. The long- term goal of this career development award is to promote Dr. Creutzfeldt's development into an independent physician-scientist working to understand and improve the quality of care early after severe acute brain injury. Dr. Creutzfeldt will conduct a prospective cohort study employing an established palliative care needs checklist that is in daily use in our neurological intensive care unit (neuro-ICU). The aims of this project are to identify those patients and families at highest risk for poor outcome and at highest need for a palliative care intervention, and to test the feasibility of a multifaceted communication intervention to meet the palliative care needs of this unique patient population and their families. To support her career development, Dr. Creutzfeldt proposes an integrated curriculum consisting of practical experience in designing, conducting and publishing clinical research; coursework in epidemiology, biostatistics and health services research; and intensive mentoring by experts in the fields of palliative care, neurology and critical care. Moreover, she will develop expertise in survey-based outcome assessment, clustered and longitudinal statistical methods, and qualitative data collection and analysis. This proposal has important implications for patients with severe acute brain injury and their families. Understanding the specific palliative care needs and how they affect long-term outcomes will inform the development of palliative care interventions to reduce distress and improve outcomes for these patients and their families.